NR-510 Week 4 Case Study: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing
Week 4 Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study
Hello Dr Regalado and Class,
After reading and analyzing the case study, I think that Stephanie stepped out of her scope of practice as a medical assistant (MA). According to (AAMA) American Association of Medical Assistants (AAMA) (2019), other state has specific MA duties that they may legally perform. Here in Ohio, MA works under the doctor’s supervision and can be assigned by a doctor to carry out duties based on standards met by the MA. The MA’s duties includes taking vitals, performing aseptic procedure, assisting patient to get ready to be seen by doctor, perform blood draw but not intravenous injection, observes and report patient changes to physician, provides basic care, assist physician with procedure or treatment, operates basic medical equipment, obtain labs through physicians direction, give medication as directed by physician, and performs administrative or office duties as directed by physician (Balasa, 2019). It is MA’s duties and responsibility to follow Ohio medical assistant scope of practice, ethical and legal standard of practice. In this case scenario, Stephanie failed to adhere to her scope of practice and violated the ethical code of conduct by not communicating to me (Nurse Practitioner) regarding Mrs Smith condition a week ago. Another bigger issue is that Stephanie provide unauthorized amoxicillin prescription to Mrs Smith under my name without my knowledge. Here in Ohio, it is considered a criminal action if an individual use someone else identity to prescribe or provide intervention. Her action could have led Mrs Smith to a more serious reaction to amoxicillin (American Association of Medical Assistants, 2019). The legal implication in this case scenario is that not only Stephanie will lose her license as a medical assistant, I could also lose my license and could face a serious legal action if Mrs Smith developed a serious complication from amoxicillin. According to Ulrich, Zhou, Hanlon, Danis & Grady (2016), Nurse practitioner are responsible in providing primary care to all the assigned patient. They are also authorized to prescribed medication under physicians’ collaboration. In this case scenario, the potential and ethical legal implication could be not knowing that their authorization to prescribed medication was used by someone else. This is a serious ethical and legal issue in behalf of the nurse practitioner and could face ethical and legal nursing board action (Ulrich et al., 2016). According to Trulove (2015), Medical director is responsible in acting as the head of the care team therefore, he or she is responsible in making sure that each clinician provides care to their patients in accordance to their scope of practice. The potential ethical and legal implication of medical director in this case scenario is the failing to ensure that MA’s performs their duties based on their scope of practice and job description (Trulove, 2015).
I think that one of the best ways to prevent or combat illegal behavior within the clinical area is to hold everyone accountable with their action. According to Esfandnia, et al., (2015), holding everyone accountable promotes positive work performance and prevents employee unethical behavior which leads to a more productive work environment. In addition, holding everyone accountable addresses the gap among employees understanding on their ethical and legal duties on their patient (Esfandnia, et al., 2015).
The qualities of a leader that I would use to promote a positive change within my work place is the ability to understand the change, promote the change and support the change. I think that not everyone is born as a leader, however, there are many sets of skills that can be applied and used as an effective leader (Esfandnia, et al., 2015). For example, in my previous BSN classes, I remember taking initiative in assigning tasks to my team member and asking their opinion on proper topic distribution of the project. In addition, using critical thinking, I do believe that to be an effective leader it is vital to poses critical thinking in order to provide the high standard of leadership. Furthermore, listening attentively to my team and accepts their opinions and feedback, it is important as a leader to be receptive to all the feedback from the team member because it will help in becoming successful towards the proposed change. An effective leader influenced team members or other in a positive way, therefore becoming a role model and motivation by others is a true characteristic of a leader (Esfandnia, et al., 2015),
American Association of Medical Assistants (2019). State scope of practice law: Ohio. Retrieved from
Balasa, D.A., (2019). The role of medical assistants in increasing colorectal cancer screening rates. CMA Today, 4(54), 1-11. Doi: 10.1136.2019.
Esfandnia, F., Mohammandi, E., Mohammandi, M., Cheraghi, R., Esfandnia, N., & Esfandnia, A. (2015). Relationship between patient safety and accountability of nurses in al-zahra gilangharb hospital in 2015. Journal of Medicine and Life, 8(3), 141-145.
Trulove, W.G. (2015). Legal issues for medical director. Clinical Journal of the American Society of Nephrology, 10(9), 1651-1655. doi: 10.2215/CJN.
Ulrich, C.M., Zhou, Q., Hanlon, A., Danis, M., & Grady, C. (2016). The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the united states. Applied Nursig Research, 27(3), 152-156. doi:
Hello Dr Regalado,
Thank you for your response! In healthcare industry we are committed to provide the most current and safest patient care. For example, nurses provide nursing care, healthcare services such as health promotion, cares for individual, family and or community using holistic approach and in accordance to the scope of practice. I believe that every healthcare member from nursing assistant to administrators have ethical and legal responsibility to make sure that the patient is safe from harm.
I do believe that the MA should be held accountable with her unethical action. Putting the patient heath at risk is not what we do in nursing or in healthcare field. Also, I completely agree with you that further education among staff is pivotal especially to the MA. Her experience and confidence of being an MA for over 10 years doesn’t make her knowledgeable and allowed to prescribe medication. In addition, the MA in this case scenario needs to review the MA code of ethics to refresh her knowledge about her ethical and legal responsibility as a healthcare member.
Thank you for your response. I agree with you that the MA should be coached on policy and procedure and specially her scope of practice. As I have mentioned every healthcare member from nursing assistant to administrators have ethical and legal responsibility to make sure that the patient is safe from harm. In this case even though it didn’t cause any harm to the patient, the MA violated her scope of practice and ethical responsibility. I think that there should be further investigation on this matter before reprimanding Stephanie.
My thoughts on coaching versus harsher sanctions, I think that it would be lawful to follow what is the best actions based on the issue, for example if Stephanie MA who has been working for 10 years in this facility committed multiple unethical actions, she should be terminated. I think that when a worker violates his or her scope of practice, it is not being careless it is however illegal which makes it a crime. Stephanie doesn’t have to be terminated although she has to be held accountable for her actions so that other coworkers becomes more responsible and follow their respective scope of practice.